2. INTRODUCTION
• Heart failure is often referred as
congestive heart failure (CHF).
Occurs when heart is unable to pump
sufficiently to maintained blood flow
to meets the body needs
This condition results of -
• SYSTOLIC DYSFUNCTIONS OR
• DIASTOLIC DYSFUNCTIONS.
3. INCIDENCE
• More than 20 million people have heart
failure worldwide
• Prevalence of heart failure in India due to
coronary heart disease, hypertension, obesity,
diabetes and rheumatic heart disease to range
From 1.3 to 4.6 million, with an annual
incidence of 491 600-1.8 million.
• Heart failure is the leading cause of
hospitalization in people older than 65
5. LHF
• In left sided heart failure, left ventricle cardiac
output is less then volume received from
pulmonary circulation; blood accumulates in the
left ventricle, left atrium.
• pulmonary congestion forcing fluid from
pulmonary capillaries into pulmonary tissue and
alveoli causing pulmonary interstitial edema and
impaired gas exchange.
6. RHF
• In right sided heart failure right ventricle cardiac
output is less then volume received from the
peripheral venous circulation, blood
accumulates in RA, RV and peripheral venous
system.
• Increased venous pressure lead to JVD and
increased capillary hydrostatic pressure
throughout the venous system
7.
8. FORVWARD V/S BACKWORD
• Backward Heart Failure: One of the ventricles
fails to pump out all of its blood that comes
into it. Thus, the ventricular filling pressure
and systemic or pulmonary edema increase.
• Forward Heart Failure: The heart is not
pumping out enough blood to satisfy the
needs of the cells of the body.
9. ACUTE V/S CHRONIC
• Acute failure occurs in response to a sudden
decrease in cardiac output which results in rapid
decrease in tissue perfusion.
• So chronic failure, body adjusts to decrease in
cardiac output through compensatory
mechanism which results in systemic
congestion.
10. ETIOLOGY
The incidence of heart failure increases with
advancing age and coronary artery disease
• Diabetes
• Cigarette Smoking
• Obesity
• Elevated Total Cholesterol
• Abnormally High Or Low Hematocrit Level
• Proteinuria
Common Precipitating Causes Of Heart Failure Are As
Follows
• Anaemia
• Infection
11. CONT……
• Thyrotoxicosis is a condition in which you have too
much thyroid hormone in your body.
• Arrhythmias
• Bacterial Endocarditis
• Valvular Dysfunction
• Pulmonary Embolis
• Paget's disease of bone is a chronic disease of the
skeleton. In healthy bone, a process called remodeling
removes old pieces of bone and replaces them with new,
fresh bone. Paget’s disease causes this process to shift out
of balance, resulting in new bone that is abnormally shaped,
weak, and brittle.
20. DIGOXIN
• Exerts a direct and beneficial effect on the
myocardial contraction in the failing heart.
• Improved cardiac output enhances kidney
perfusion, which may create a mild dieresis
of sodium and water
• DOSE: 0.125-0.25 mg PO/IV qDay; higher
doses including 0.375-0.5 mg/day rarely
needed
21. BETA-BLOCKERS TO TREAT CHF
• Coreg (carvedilol)—6.25-50 mg; one 3.125, 6.25,
12.5 or 25-mg tablet 2x/day with food.
22. INOTROPES
• Agent such as dopamine, dobutamine and
amrinone may be ordered for clients with very
low output heart failure.
• These medications facilitate myocardial
contractility and enhance stroke volume.
• dopamine given in small doses(< 4 ug/kg/min)
23. ACE INHIBITORS
• ACE inhibitors can raise potassium levels
• Accupril (quinapril)—20-40 mg; one 10 or 20
mg tablet 2x/day on an empty stomach, 1 hour
before or 2 hours after a meal or with a light,
low-fat meal.
• Altace (ramipril)—10 mg; one 5 mg capsule
2x/day with or without food. Swallow capsule
whole.
24. WATER PILLS
• There are many brands of diuretics. Some are
taken once a day. Others are taken 2 times a day.
The most common types are:
• Thiazides. Chlorothiazide (Diuril),
chlorthalidone (Hygroton), indapamide (Lozol),
hydrochlorothiazide (Esidrix, HydroDiuril), and
metolazone (Mykrox, Zaroxolyn)
• Loop diuretics. Bumentanide (Bumex),
furosemide (Lasix), and torasemide (Demadex)
25. SURGICAL MANAGEMENT
HEART TRANSPLANTATION:
When the heart is irreversibly managed and no
longer functions adequately and when the
client is at risk of dying, cardiac
transplantation and use of an artificial heart to
assist or replace the failing heart are measures
A heart transplant, or a cardiac
transplant, is a surgical transplant procedure
performed on patients with end-stage heart
failure or severe coronary artery disease when
other medical or surgical treatments have
failed of last resort.
26. CONTAINDICATION
Absolute contraindications:
• Advanced kidney, lung, or liver disease
• Active cancer if it is likely to impact the survival
of the patient
• Life-threatening diseases including acute
infection or systemic disease such as systemic
lupus erythematosus, sarcoidosis, or amyloidosis
Vascular disease of the neck and leg arteries.
• High pulmonary vascular resistance - over 5 or 6
Wood units.
27. Relative contraindications
• Insulin-dependent diabetes with severe organ
dysfunction
• Recent thromboembolism such as stroke
• Severe obesity
• Age over 65 years (some variation between
centers) - older patients are usually evaluated on
an individual basis.
• Active substance abuse, such as alcohol,
recreational drugs or tobacco smoking (which
increases the chance of lung disease)
28. HEART TRANSPLANTATION
Pre-operative
• A typical heart transplantation begins when a
suitable donor heart is identified. The heart
comes from a recently deceased or brain dead
donor, also called a beating heart cadaver.
• . The patient is also given immunosuppressant
medication so that the patient's immune system
does not reject the new heart.
29. CARDIOMYOPLASTY
• Cardiomyoplasty is a surgical procedure in
which healthy muscle from another part of the
body is wrapped around the heart to provide
support for the failing heart.
• Most often the latissimus dorsi muscle is used
for this purpose.
• A special pacemaker is implanted to make the
skeletal muscle contract. Cardiomyoplasty is
related to damaged myocardium remodeling.
31. It is a Electromechanical device for assisting
cardiac circulation, which is used either to
partially or to completely replace the function of
a failing heart.
The function of VADs is different from that
of artificial cardiac pacemakers; some are for
short-term use, typically for patients recovering
from myocardial infarction (heart attack) and
for patients recovering from cardiac surgery
33. Cardiac Resynchronization
Therapy (CRT).
• It resynchronizes the contractions of the
heart’s ventricles by sending tiny electrical
impulses to the heart muscle, which can help
the heart pump blood throughout the body
more efficiently.
• CRT defibrillators (CRT-D) also incorporate
the additional function of an implantable
cardioverter-defibrillator, to quickly
terminate an abnormally fast, life-threatening
heart rhythm.
